Sorry, did I wake you?
Yes.
The baby's pressing on my bladder,
so I have to pee approximately 78 times every night.
We can talk about baby names since we are both awake.
I keep coming back to one name... Kelly.
It reminds me of a Kelly clamp.
And I will think about grasping onto tissue
or vessels every time I'm holding our son.
What about Addison?
Addison Murphy.
Addison is the name of a disease.
I'll worry our son is not producing enough cortisol or aldosterone.
You can go back to sleep, I have to go pee again anyway.
Good morning. Pancakes, anyone?
They are not just ordinary pancakes.
They are Dutch baby pancakes,
also known as Bismarcks, Dutch puffs, and even Hootenannies.
- I looked it up. - That is correct.
They're baked in the oven not fried. I was up early.
Sorry if my frequent bathroom trips kept you up.
Don't be silly. You're making a human.
Thank you.
So, Kelly and Addison are out, I don't disagree.
How about Munchausen?
- Shaun... - Or Parkinson?
Our bedroom conversations are private.
All of them?
It's not like we were talking about--
Never mind.
Let's eat.
A friend on the San Jose schoolboard reached out,
they're looking for someone to give a series of online talks
to high schoolers about careers in medicine.
Specifically to young women of color.
- That's great. - I thought you'd be perfect.
Oh.
That wasn't the reaction I was expecting.
Maybe Dr. Tooks can do it?
Tooks is a mom,
these high schoolkids don't see themselves in her.
- There's gotta be someone else. - There isn't.
Only 2% of surgeons in the U.S. are black.
Don't be afraid to step into the spotlight.
I'm not afraid, I'm just very busy.
Okay. It'll only take a couple hours of your time.
"If you can see it, you can be it" is a real thing...
It's not my responsibility to be the one they see.
Okay.
Nathan hit his head on the trampoline frame
at his birthday party.
He got a bump, but he seemed fine...
Where's daddy?
I told you, he's at work helping people. He'll be back in a few days, okay.
Is it possible to develop a concussion two days later?
Let's see if we can find out what's going on.
Nathan, what's your puppy's name?
Patches.
Can I look into Patches' eyes with this light? Make sure he's okay?
Or you can do it?
Just look in here.
Can you pick this up and give it to the doctor?
I can't. Where's daddy?
Can you give me a high five, bud.
Good. Now high ten.
What is happening? Is this a concussion?
It's not a concussion.
Your son is having a stroke.
- You are late. - No, I'm not.
It's 8:01 am.
It-- It is now.
But I'm sure it was still 8:00 when I walked through the door.
Were you getting your hair cut?
No.
Are you using drugs again?
No.
You are on probation and I am responsible for you.
Common signs include ignoring responsibilities
and secretive behavior.
I promise, I'm clean.
I'll pee in a cup if you want.
Okay.
I'm going to assist Dr. Park.
You can join the case if your sample comes back clean.
I wasn't even late.
A chance to help young diverse women
and kiss the hospital president's ass at the same time?
There's only one answer to that
and it starts with a "y" and ends with a "yes."
- That didn't work. - I know. But I stand by my point.
Aren't we busy enough?
Why do I have extra homework because I have more melanin?
And why is my Grandma E texting me?
You shouldn't think of it as homework
and you shouldn't think of it as a burden.
You shouldn't think you know what it's like to be me.
Point taken.
What the...?
Okay, can we just focus on our patients, please?
Quinque, there you are.
Grandma E? What are you doing here?
I was told they have doctors here.
I've got tightness in my chest, shortness of breath, swollen ankles--
Didn't you see your doctors in Oakland?
Those idiots said my ascites indicated "cirrhosis of the liver"
like I'm some kind of drunk.
I figured with my family connections,
I could get top- shelf care here.
I can't be involved in any of your--
But I can.
Delighted to meet you Grandma E, I'm Dr. Wolke.
Okay, Jordan baby, you stay and keep an eye on little mister here.
He might try to skate by on his good looks.
Can you lean back for me?
Jordan, you never mentioned having a sister.
See, I like him.
Distended jugular veins with increased JVP.
Kussmaul's sign and Pulsus paradoxus.
Maybe I don't like you so much now.
She does have a history of chest radiation.
- Echo-brightness of the pericardium. - What does that mean?
The sac around your heart is inflamed and there are calcium deposits.
Grandma?
- Faint pulses. - Let's do something before she arrest.
Set up an O.R. STAT for a pericardiotomy.
No, Rick, stay. I promise I've got this.
Sorry to interrupt. We're ready.
Can you please talk to my husband?
Of course.
This is Doctor Park.
How does a four year old end up with a stroke?
Head trauma is one of the main causes.
I feel like I should get on a plane now, but Linda's telling me to stay.
- How far are you? - Alabama.
We still have people missing after the tornado ripped through.
I can't tell you how to prioritize.
I'm hoping to make your son better well before you could get here.
Thank you.
We're okay.
And you'll be back in a few days anyway. Just stay and keep helping.
Okay.
Evacuating the hematoma.
I saw on the Weather Channel
that the Alabama tornado was the 15th to reach a four
on the Enhanced Fujita scale in the last three years.
Together they have caused 116 fatalities.
Luckily we have people like his Dad who run towards a crisis.
But he also has a crisis right here with his son.
He didn't know that when he left.
I'm not seeing an active bleeder.
There is a hyper-vascularized brain parenchyma in this resection cavity.
The major named vessels are all smaller than usual,
and look scarred in.
The hemorrhage was not from hitting his head.
This boy and his brain are even sicker than we thought.
Lighting the sternal retractor.
So why does she call you Queen K?
It's Quinque.
Latin for five because I'm the fifth child of six.
Does she call your little brother Sex?
Please focus so you don't kill my grandmother.
Cauterizing the edges of the sternal periosteum.
She's so charming.
Why didn't you get any of those genes?
Charm is one of many layers of a very complicated woman.
Grandma E drove me like a drill sergeant from the day I was born.
Ensure the pericardium is free from both the pleurae and the diaphragm.
15 blade.
I need a new 15 blade...
What's happening?
I can't pierce it. Never seen constrictive pericarditis this severe.
It's completely calcified.
Your grandma has what's known as coconut heart.
Your son has a rare auto-immune disorder called Primary CNS vasculitis.
It's causing inflammation of his blood vessels throughout his brain.
Okay. What are the next steps?
Cyclophosphamide infusions.
That's chemo.
My mother had that when she had breast cancer
and she lost her hair, threw up, got sores all over her mouth.
Letting this go untreated is far worse.
Recurrent brain bleeds, possibly large territory strokes.
They could be fatal.
Nathan will be on some form of immunosuppression
his whole life.
I'm sorry.
Thank you, Doctor.
How do you crack a coconut without puncturing what's underneath?
Constrictive pericarditis.
Please stop saying coconut. It's my grandmother and it's serious.
Not your case.
I'm just having a snack and trying to help--
We need ideas.
Left anterior thoracotomy and partial excision of the pericardium.
Avoid sternal infection and seems likely the safest route.
It'll require more surgeries.
Please go away.
Wait, what are you advocating for?
Complete removal.
A median sternotomy gives us
clear access to the diseased pericardium from phrenic nerve to phrenic nerve.
It's way too risky.
Complete decortication fixes her heart.
Completely.
You're advocating for an extensive, high-risk surgery.
Meanwhile, partial removal
offers your 70-year-oldgrandmother a shot at full health
for what likely amount to the rest of her life.
Shouldn't you let the patient decide?
No. I don't present something if it's not a viable option.
I think it is viable.
Her surgeon doesn't.
Jordan, go be a granddaughter.
If I hadn't become a surgeon, I think I would've been a writer.
You never told me your grandmother worked at Marcus Books.
Was I supposed to?
I was just a lowly clerk.
It came up when I heard his name was Marcus.
There is nothing lowly
about being at the center of a cultural landmark.
My Auntie Winn used to take me to author readings
by Toni Morrison, Maya Angelou...
and you were there everyday.
I probably served you some cookies.
- Did you ever meet, James Baldwin? - I did.
Okay. She can probably use some rest.
Yes, absolutely.
If you need anything at all, Ms. Evelyn, you know where to find me.
- Thank you, Marcus. - Yes, ma'am.
Marcus Books. Wow!
That was weird.
Not as weird as you refusing to do his mentorship program?
Let's talk about you...
and your heart.
Your pericardium has become hardened, likely from your cancer treatments.
So what happens now?
Dr. Lim has decided on a partial removal.
And you think that's best?
Jordan Jacqueline Allen, you look at me and you tell me,
if you think it's best.
Wow, it took you guys a while to get home?
We went out to dinner. Because Lea thought that--
Why are you on the floor? What's with the high chairs?
I stopped at Costco on the way home.
Surprisingly diverse selection of wines.
There's an open bottle if you guys want--
Although that might be empty.
Danger!
I remember wine. Are you drunk?
No. Maybe a little.
I'm baby-proofing. Danger!
Are you okay?
Oh, you guys got to get down here and check this out.
From the baby's perspective, this place is a fricking death trap...
for Nicholas. Place holder name.
We can call him Nick, Nicky.
I like Nicky.
Why did you buy three high chairs?
One's a gift for you, and the other two I'll take back. Danger!
That could be dangerous.
You don't have to buy us anything.
I also got you a nanny cam.
It's-- It's-- It's a teddy bear,
but you wouldn't believe there is a camera inside.
That is very practical... and cute.
Okay. We will not need a highchair or baby proofing for a year.
And we'll not name our son Nick, Nicholas or Nicky,
or any variation thereof.
Okay.
That's fair enough but you're going to want this,
it's a book by Dr. Spock on parenting.
Everyone read this book back in the day,
he was so popular, he ran for president.
Danger.
I'm going to bed.
Yeah, but-- You're going to want to read this
before the baby comes and you get exhausted.
Already there.
Danger!
What were you thinking?
My grandmother deserved the good muffins?
She'll only agree to complete decortication,
which she shouldn't know about.
You do not present a patient with an option
that I've deemed unsafe and wouldn't even perform.
- It's unacceptable. - You're right.
I felt like your plan was a little conservative--
You are a resident,
your feelings about my decisions are not relevant.
- I'll tell her I was wrong. - And convince her I'm right.
Or find her another hospital.
Yes, ma'am.
Your muffins are ready.
How's he handling the chemo?
You doing okay, bud?
Nathan, can you answer Doctor Park, please? Is everything okay?
No.
You're right. It's not okay.
Okay, those aren't toys.
We okay, mom?
He's got dozens of new toys for his birthday...
he shouldn't have to be building castles with pill bottles.
I'm sorry.
You shouldn't be trying to do all of this alone.
My husband is saving lives. I can't pull him away from that.
I can.
Give me your phone.
Hi Rick, Doctor Park.
You okay?
Yeah. I'm fine.
But you are not.
What happened?
I was wrong to question Dr. Lim's surgical advice.
She is the best.
I hope to be her someday.
And if she thinks the partial removal of the pericardium
is the best course of action, then I agree with her.
Okay.
Then that's what I'll do.
But why did you go against her advice in the first place?
I felt like I needed to do extra.
To be a hero.
Why?
Since I was little, you told me I had to work twice as hard,
be twice as good as everybody else.
After all these years,
I'm still striving to be good enough for you.
Now see that's a lot of pressure.
But it's what the world requires from people that look like you and me.
When is my daddy coming?
Your daddy is getting on a plane, he's gonna be back soon.
But now, we have to see if the medicine is working, okay?
If it is, can I stop taking it?
I'm so sorry. You still need it.
I hate it.
I know.
Let's play a game, like hide and seek, okay?
Here, lie down.
You get to go in the tunnel.
And stay very still so nobody can find you...
I'll come back and get you when the coast is clear. Sound good?
You are very good with him.
Starting the imaging.
Thanks.
Nathan, you're about to hear some banging. It's just the machine
but remember to stay really still, okay?
I am.
Try a little harder, okay, bud?
Motion artifact, we might have to sedate him.
Those are not artifacts.
He does not have CNS Vasculitis, he has Moyamoya disease.
What the heck is that?
A narrow carotid artery is reducing blood flow to his brain.
This area here, looks like a puff of smoke?
That's what moyamoya means in Japanese,
A bunch of new, tiny vessels have developed
to circumvent the blockage,
but because the vessels are abnormal, they're prone to bleeds.
We can fix the problem with a very interesting brain surgery.
So now that you're done poisoning our son with chemo that he didn't need,
we should trust you to crack open his skull?
We will use a small craniotomy to access--
I get why you're frustrated.
Moyamoya is rare and notoriously hard to diagnose.
Many kids get chemo they don't need for a lot longer.
We're hoping to do Nathan's first brain surgery tomorrow.
He needs more than one?
What's brain surgery?
Hey.
It's how we're going to make you all better.
No more chemo?
No more chemo.
Are you going to be here?
My plane got cancelled, buddy,
but look, I promise I'm going to be there as soon as I can, okay?
Can Patches get brain surgery, too?
No. Patches is a stuffed animal, it does not have a brain.
I just peed in our bathtub.
Glassman has to go.
- Hey! - Sorry!
First years.
You are late again.
C'mon. Like one minute.
Last time...
Your drug test from yesterday was negative,
you are not using. So what is causing your tardiness?
Look, I'm sorry.
I've been doing really well.
And the reason I'm doing so well
is my daily meeting.
Sets my mind right. It's kinda far. And there's morning traffic.
Support is very important.
And so is punctuality.
I'm going to map a complex double-barrel vascular bypass.
- Dang it. - That's the 6th time you've killed her.
It wasn't working with the rongeur, need little more power.
- And the right torque. - That's reassuring.
Stop hovering and go visit, visitor.
Convincing Evelyn Allen to do a surgery,
after convincing her not to, was a little bumpy.
Details, please.
I took the opportunity to explain
how much pressure she's put on me,
and she took that opportunity to make me feel inadequate once again.
I've never thought of you as someone who lacks for confidence.
Fake it till you make it.
You're a resident in one of the top surgical programs.
You've already made it.
All I see is the ground I've still got to cover.
How's it going?
Not ready for primetime.
This S.T.A. anatomy is ideal as a donor vessel to bypass the blockage.
So we'll reroute the scalp vessel into the brain here.
Gonna give you a little tip. Next time a child asks
if you could do surgery on his stuffed animal
so that he feels less scared? Say yes.
I was only telling him the truth.
This branch of the middle cerebral artery looks like an ideal recipient.
You're about to be a father. Children are illogical.
We can place temporary clips for vascular control,
and then anastomose the STA to the MCA using 10-0 prolenes.
I was very logical as a child.
I did not like being talked to like I was dumb
and I definitely did not like being lied to.
That child there felt that if his Dalmatian
went through this scary thing with him,
he would be less scared.
If you can embrace another person's thought process,
it can strengthen the relationship.
Lea thinks she should not have to pee in the tub,
which I understand.
No kidnapping my grandmother.
I asked him to do a lap around the floor, I needed a change of scenery.
Well, you had your lap, now back to your cell.
Thanks for the tour, Speedy.
Speedy?
I was sprinting through here this morning.
I was late.
Second time this week.
Snooze buttons are the devil's plaything.
I was actually at a Narcotics Anonymous meeting this morning.
I go every day.
"Confess your sins to each other and pray for each other
so that you may be healed."
James 5:15-16.
Amen to that.
Good for you, young man.
- There's got to be a closer meeting. - I've tried the closer one...
The hardliners who run it think
that wearing a suit and tie is key to staying sober.
Start your own meeting, here at the hospital.
Set your own tone, and you're never late for work again.
No, I'm not qualified to be a leader.
No such thing.
Leaders lead, simple as that.
You are annoying.
Well, nice to see you too, Shaun.
Not to me, but to Lea,
and I want to keep our relationship strong.
She feels your presence has taken over our apartment
and she wants her space back.
I overstepped with the babyproofing.
- And suggesting names. - And the Dr. Spock thing.
And there's more, the nanny cam.
Okay, okay. Okay.
It's was fun, thinking about your baby, and the future.
Maybe it has been a nice distraction.
Yes, it was.
Which you've needed since your house burned down
and you have no place to live.
Yes, thank you, Shaun.
Dr. Glassman, you are not exactly my family.
I get it. I know, Shaun.
But I consider you to be the baby's grandfather.
Wow.
Thank you.
I never thought that would happen for me.
Thank you.
You can stay. I will tell Lea and she will change her mind.
No, no, no. I'm going to go.
Where?
I don't know.
Can I get you a magazine?
No, thank you.
Are your pillows positioned okay?
Okay, you're doing it again.
What?
The thing you've doing since you were little...
just fussing over people...
when it's you that's in need.
Okay, c'mon. Tell me.
You just met Dr. Perez,
and you were so nice and supportive.
Do you know how long I've waited for you to say
"Good job" to me. Or "Wow, you're a doctor."
Do you know who Rebecca Crumpler is?
No.
She was the first black female doctor.
And when I read about her, I wanted to be just like her.
But unfortunately, I didn't know who she was either
until you were in med school.
Quinque... I've been impressed by you
since you were in kindergarten.
Grandma.
- What's going on? - She's having trouble breathing.
She's hypotensive.
Jugular vein distension is increased, her heart is failing.
Tell me you got through a practice run.
We were postponing the surgery so we could practice more.
What are you hanging?
It's a...
You can read obviously.
Is this okay? I'm sorry, I should have cleared it with you first.
Yes, you should have.
Because I'd have told you to use the small conference room up on six.
It's quieter up there, and the room has blinds,
to help with the "anonymous" part.
Thanks.
This is Park.
I had to fly to San Francisco, I'm just grabbing a cab now.
Can you hold the surgery until I get there?
We can't. If he hemorrhages again...
Or, can you put him on the phone?
He's already sedated.
But what if this was my last chance
to talk to him?
I'll treat Nathan like my own son.
I promise.
Thank you.
Try to puncture the pericardium
and grab an edge so we can start to peel the shell.
Apply more pressure.
We may need another tool to pierce it.
Let's try the rongeur.
Perforation of the myocardium.
Manually tamponading the hole. Pledgeted sutures.
The pericardium's just too calcified.
It's adhering to the myocardium.
So what do we do?
Repair the perforation, after that, I'm open to ideas.
We could put her on bypass.
Gently peel off the calcified pericardium bit by bit,
- and repair damage as we go. - Poking holes in a bucket
and hoping we can plug them before the water leaks out.
I have an idea.
- Go ahead. - It's called the Waffle procedure.
I found a novel study, it said
dense calcified plaques can be scored into multiple cross hatched sections.
No removal at all?
Exactly. The shell stays in place,
but the heart has room to expand and contract as it beats.
Mortality rate?
Under 8%
Talk me through it.
Okay. Ultrasonic scalpel.
Start by incising the calcified pericardium.
ICG angio looks great.
Doctor Perez, you may do the dural closure,
then replace the skull flap.
Before we close...
We're ahead of schedule. Why not go ahead with the bypass
- in his other hemisphere? - That is not the plan.
Simultaneous bi-lateral surgery risks altering brain flow,
it could cause another bleed.
But maybe there's a way to reduce that risk.
The wait will be hell on the parents, the whole time knowing their son's brain--
The parents' stress is not medically relevant.
I know, Shaun, but please...
Can you think of any other way?
An encephalo-duro-arterio-synangiosis of the left side
would be relatively low risk.
We could safely do that now.
Thank you.
Rick, Linda!
The surgery went well.
There she is, right on schedule.
How do you feel?
Like I can breathe.
For the first time in a long time.
Thank Dr. Lim for me.
I will.
Somebody's all puffed up.
You did something...
The surgical team got a little stuck.
I just gave them a new idea.
Good job.
Wow, you're a doctor.
Wow, okay. You're laying on a little too thick now.
Looking good. How are you feeling?
Okay.
Can you give me a high five?
High ten?
Good job.
Good boy buddy.
Where is Patches?
He is right here.
You did do the brain surgery on him.
No. I just put bandages on his head to make you feel better.
I do.
I'm sorry, there's a meeting.
I know. N.A. right?
Yeah.
Took me a few minutes to get the courage to come in.
It's just us. Sorry.
Where two or more are gathered...
Have a seat, please.
Hi. I'm Danny. And...
I'm an addict.
Almost show time.
Don't say it like that, you make me nervous.
Be yourself. That's more than enough.
Hi, everybody.
There's so many of you.
That's so good to see.
I'm Doctor Jordan Allen,
and I'm a third year surgical resident at St. Bonaventure Hospital.
Where's Glassy?
He will not be staying with us anymore.
- He moved out? - Yes.
We had a talk and decided it was best.
Did you tell him I was complaining about him?
Yes.
Shaun, now I feel horrible.
You don't need to.
He found a vacant apartment just down the hall.
In this building?
- Yes. - He's our next-door neighbor?
Our next-door neighbor's next-door neighbor.